May 1, 2010

Two weeks ago I received a phone call from a concert pianist and piano teacher in New York who had gradually lost his sense of smell over a period of years, to the point where only three things still smelled faintly: coffee, chocolate and shit. He had seen an ENT specialist, who apparently looked up his nose and told him that his “olfactory bulb” was looking fine, a remarkable feat considering the bulb is inside the brain. The specialist prescribed a mineral supplement, the medical equivalent of airline sweets.

Several things this distinguished musician told me were typical of most people in his unfortunate position. First, losing your sense of smell elicits no sympathy whatsoever. Second, those who lose it often feel a terrible loss because what we call taste is mostly smell, so all the pleasures of food are denied to anosmics. All you’re left with is salty, sour, bitter, sweet and umami, not much to go on. Third, the effect on mood is terrible, perhaps unexpectedly so. Another anosmia victim was the journalist Mick O’Hare, who edits the New Scientist magazine. He is as buoyant, positive a man as you’re likely to meet. Yet when he lost his sense of smell after a bad cold he considered suicide.

His story is exemplary in another respect, because he was cured. After searching high and low, he found a doctor in Washington DC called Robert Henkin who treated him with a drug called theophylline, formerly an asthma medication. It is not clear why this works, and theophylline is not without risks. However, it worked for Mick O’Hare: after over a year his sense of smell started to came back, as luck would have it, while he was on the toilet. He described this to me as “the best smell ever”.

There are basically four reasons why your sense of smell might not work. The most common is simply a mechanical obstacle preventing the air from reaching the inconspicuous patch of mucosa where the receptor cells dangle in the breeze. That can be figured out by looking up your nose. The second, and most common is post-viral anosmia. An unusually hardy rhinovirus gives you a common cold and takes the opportunity to wipe out the olfactory neurons. These normally grow back —no other part of the nervous system does that so well— but sometimes they don’t. The third reason is something wrong inside your brain, either due to a blow to the head, a tumor or a degenerative disease. Smell loss is an early indicator of several nasty illnesses from Alzheimer’s to Parkinson’s. Finally, there is a collection of other causes such as zinc deficiency, cadmium poisoning etc.

The most important thing if you suffer smell loss is not to suffer it in silence, and to find a doctor who takes it seriously. Make sure it is not a blockage, then see a neurologist. You only have five senses, and none to spare.